To assess the efficacy of medication delivery via MDI and Diskus in asthmatics instructed by different educators and to evaluate technique after months of training.
102 consecutive patients admitted to an adult medical service with the diagnosis of bronchial asthma were entered into a prospective study to grade medication technique with MDI and/or Diskus and instruction source (pulmonologist, internist). The patients were scored on an Inhalation Performance Index (IPI): a set of 9 (discus) or 10 (MDI) pre-set criteria used by interviewers. 58 patients were divided into 4 groups and followed in clinic every 2 months for 10 months. Each visit patients received instructions on technique from either a pulmonologist/fellow, internist/resident, nurse or no one. IPIs were reevaluated at the end of 10 months.
Pulmonologist trained IPI for MDI 6.28/10 (62.8%) vs. 7.07/9(78%) for Diakus. Internist trained IPI for MDI 5.9/10(59%) vs. 6.6/9 (73%) for Diskus. 10-month follow-up group: pulmonologist/fellow trained IPIs were MDI 8.17/10 (81.7%) vs. 7.43/9 (82.6%) for Diskus. Internist/resident trained IPIs were MDI 7.82/10 (78.2%) vs. 7.23/9 (80.2%) for Diskus. The Nurse group IPIs were MDI 7.68/10 (76.8%) vs. 6.78/9 (75.3%) for Diskus. The non-taught group IPIs for MDI and Diskus were 5.84/10 (58.4%) and 5.86/9 (65.1%) respectively. The number of emergency visit and admission for asthma in the follow-up patients were 11 (23.9%) and 6 (13%) respectively, while non-follow-up group had 4 (40%) and 3 (30%) respectively.
The Diskus users had a higher mean IPI score regardless of instruction source. Pulmonologist trained IPIs were better compared to internist or nurse trained groups. With proper instruction and close follow-up improved IPI scores were obtained. Increased IPI translated into fewer ER visits and hospitalization. Thus, proper use of MDI/Diskus can be achieved with persistent training and may improve asthma stability.
Better technique would enhance treatment efficacy and reduce both ER visits and hospitalization. This will greatly decrease the overall cost of asthma management and improve quality of life for asthmatics.
R. Khan, None.